29.8 Clinical Care for Emergencies Flashcards
Triggers for Anaphylaxis
(1) Drugs (Antibiotics, NSAIDs, ANYDRUG)
(2) Food (nuts, shellfish, soy, eggs)
(3) Additives (sulfites)
(4) Toxins (insect stings, venom)
(5) Chemicals (contrast dye, latex)
Signs and Symptoms
(1) Classic Presentation
(a)Pruritis
(b)Flushing
(c)Urticaria
(2) Progression
(a)Throat fullness (lump sensation)
(b)Anxiety
(c)Chest tightness, SOB, Lightheadedness
(3) Severe reaction
(a)Loss of consciousness
(b)Cardiorespiratory arrest
(4) Signs and symptoms begin within 60 mins of exposure
(5) The faster the onset, the more severe the reaction
(6) After resolution of symptoms, patients at risk for recurrence
(a)21% will have a reoccurrence within 12 hours after resolution of the first episode
Anaphylaxis
With suspected anaphylaxis, the single most important step in treatment is the rapid administration of
Epinepherine
Management steps for anaphylaxis
(a)REMOVE AGENT (no gastric lavage)
(b) Primary Survey (adjuncts, advance airway options, cricothyrotomy); airway challenges
(c)IV/IO, O2, monitor, lines
(d) EPINEPHRINE 0.5 mg IM is the preferred route
(e)Bolus with fluids (NS or LR)
(f)Secondary Survey
(g) MEDEVAC/MEDAVICE
Second line therapies for Anaphylaxis
- Methylprednisolone (Solumedrol) 125mg IM/IV daily x 2 days
- Diphenhydramine (Benadryl) - 25-50 mg IV
- Nebulized albuterol 5mg nebulized or via inhaler every 15-30 minutes as needed for bronchospasm
Food allergy characteristics
(a) Obtain detailed history, typically mild
(b) Swelling and itching of lips, mouth, throat, epinephrine if airway symptoms develop
(c)Nausea, vomiting, diarrhea, abdominal cramps Cutaneous symptoms
(d) Antihistamines and trial elimination diets are gaining popularity as treatment modalities
Drug Allergy sx
(a) Usually within the first or second week
(b) Pruritus
(c) Urticaria
(d) Fever
(e) Erythema
(f)Angioedema
(g) Stevens-Johnson (SJS) or toxic epidermal necrolysis (TEN)
(1)Nonspecific group of injuries that describes injury to the respiratory tract including upper airway, tracheobronchial tree and pulmonary parenchyma
(2)Caused by heat, smoke or chemicals
(3)Fire is the leading cause of injuries.
Smoke Inhalation injury
Smoke inhalation causes what kind of injury to the upper airway
Thermal Injury
What in smoke inhalation causes injury to tracheobronchial tree
Chemicals in the smoke
How does smoke inhalation affect lung parenchyma
Injury to the lung tissue, usually a delayed process.
What is systemic toxicity
caused by breathing toxic substances. Two most relevant gases are carbon monoxide and hydrogen cyanide
Which substance describes the following:
1)Frequent cause of death and most common complication after inhalationinjury
2)Colorless and odorless gas
3)Affinity for hemoglobin 260 times greater than oxygen
4)Of note, O2 sat cannot screen for it as it does not differentiate between oxyhemoglobin and carboxyhemoglobin
Carbon Monoxide (CO)
Which substance describes the following:
1)Gaseous form is colorless and odor of bitter almonds
2)Difficult to screen for and treatment should be considered in all inhalation injuries
3)Treatment should be initiated patients who are at risk and who display altered mental status, cardiac arrest or signs of heart failure
Hydrogen cyanide
Hallmark sx for Upper Airway Smoke inhalation injury
Dyspnea
Hallmark sx for Lower Airway Smoke inhalation injury
Productive cough
Clinical findings include
(1 soot around nares,
(2 carbonaceous sputum,
(3 obvious burns to neck and face,(4 stridor,
(5 drooling,
(6 dysphonia
(7 dyspnea
Upper Airway Smoke inhalation injury
Clinical findings include
1)tachypnea,
2)decreased breath sounds,
3)adventitious lungs sounds
4)accessory muscle use.
5) productive cough
Lower respiratory tract and parenchyma smoke inhalation injury
Lab studies for smoke inhalation
1)CBC,
2)Chemistry panel,
3)Lactate and
4)Any available toxicological screens (CO/ABG/VBG)
Rads for smoke inhalation
Chest X-Ray
1)Typically obtained early in the course.
- May be normal initially however, it is useful as a baseline.
Why would you get an EKG for smoke inhalation
1)Useful in any patient being evaluated for toxicological purposes.
2)CO poisoning can lead to myocardial ischemia
Treatment of Smoke inhalation
(1)First step is rescue from source and limit exposure time
(a)ABC’s and ATLS protocols with frequent re-assessment
(b)For critically ill patients secure the airway and initiate prompt MEDEVAC as needed
(c)Signs of thermal injury to the airway - intubation is indicated
(d)Significant burns (>40%) even with an airway that seems intact might require prophylactic intubation if capability exist due to impending edema and airway compromise
(e)Provide 100% O2 by tight fitting mask or via endotracheal tube.
(f)IV Fluids for burns
(g)Inhaled bronchodilators for bronchospasm
(h)Prevent hypothermia
Medications for smoke inhalation
Albuterol
- Acute treatment: 1 to 2 inhalations every 2 hours for the first 4 hours; additional inhalations may be necessary every 4 to 6 hours as needed if inadequate relief
- Maintenance (in combination with corticosteroid therapy): 1 to 2 inhalations every 4 to 6 hours as needed (maximum: 8 inhalations daily)
When should hyperbaric oxygen be given for smoke inhalation
Hyperbaric oxygen for significant CO toxicity in consultation with specialist
